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183 Cards in this Set

  • Front
  • Back
When should you suspect an acid-base disorder?
abnormal respiration
altered bicarb
poor o2sat
protracted vomiting/diarrhea
altered mental status
What tests do you do to evaluate a person with an acid-base disorder?
ABG's and chem panel
What is the purpose of allens test?
unlar circulation.

REQUIRED: because if you do a radial artery ABG, and the danm thing
How are ABG's written out? because they will hoze us on this
pH/pCO2/pO2/HCO3/O2 sat/Base excess
How do base excess related to acidosis or alkalosis?
acid, if base has negative -2 or less excess

basic if base has +2 or more excess
what is normal blood ph range?
7.35-7.45
What is the primary problem in metabolic acidosis?
low plasma bicarb
what is the primary problem in respiratory acidosis?
increased pCO2
What is the primary problem in metabolic alkalosis?
increased plasma bicarb
What is the primary problem in respiratory alkalosis?
decreased pCO2
what is normal pCO2 level?
40
What is normal HCO3 level?
24
Will physiologic compensation of a primary acid base disorder normalize the pH?
nope never on its own
How does total venous CO2 relate to ABG bicarb?
these should be about the same, or within +/- 3mmol/L
How does pH change with variations in H+ nEq/L?
the ph should change about .01 for every unit (1) change in H+ nEq/L in the Opposite direction***

(which makes sense, the more H+, the more acid, or lower pH)
IF acidotic and pCO2>40 it is?
this is respiratory acidosis (due to high CO2
If acidotic and HCO3<24 it is?
metabolic acidosis, due to low HCO3
if alkalotic and pCO2 <40 it is?
respiratory alkalosis
if alkalotic and HCO3 >24 it is?
metabolic akalkaosis
What is the ANION gap calculation?
NA- (Cl + HCO3) = gap
What is the normal anion gap?
about 16
what does an anion gap >20mmol/L predict?
primary metabolic acidosis
What does an Excess anion gap >30 indicate?
metabolic alkalosis
What does an excess anion gap <23 indicate?
this indicates a non-anion gap metabolic acidosis
How is excess anion gap calculated?
(Anion gap- 12) + Measured bicarb (or venous Co2)
What are the 7 things that cause high anion gap acidosis (anion gap above 20)
MULE PAK
Methanol
Uremia
Lactic acidosis
Ethylene glycol

Paraldehyde
Aspirin
Ketoacidosis
What are the signs of ethylene glycol ingestion
elevated osmlar gaps
calcium oxalate crystals
What is the normal osmolar gap?
less than 10
What do you suspect if osmolar gap is greater than 10?
methanol or ethylene glycol ingestion
how do you calculate osmolar gap?
measured osmolalty- calculated osmolality

where calculated is 2(Na) + BUN/2.8 + glucose/18
Why does dehydration push metabolic akalaosis along?
the kidneys start to spare Na and fluid, rather than sparing H+.

and to spare Na (and volume) the kidneys will reabsorb NaHCO3- making the alkalosis worse

normally it would spare H+ by dumping K and Cl
What does a urine chloride below 10 meq/l and alkalosis indicate?
this indicates a NaCl responsive alkalosis
How does the potassium level change in metabolic acidosis?
as pH decrease, serum potassium increases
How do you calculated the correct K+?
for each .1 change in pH, K+ changes by .6mEq/L in the opposite direction

normal K+ is 3.7-5.2
What is the ROME III criteria for dyspepsia?
1 or more of:
postprandial fullness
early satiation
epigastric pain or burning
how often is dyspepsia functional/idiopathic?
up to 60% of the time
What are the alarm symptoms in dyspepsia?
unintended weight loss
persistent vomiting
progressive dysphagia
odynophagia (painful swallowing)
anemia
hematemsis
abdominal mass
family hx of upper GI cancer
prior gastric surgery
jaundice
What do you do if your pt is over 45, and has dyspepsia alarm symptoms?
Upper GI endocopy
What is the first treatment for H pylori negative dyspeptics?
4-8 week PPI trial
What are the four major risk factors for upper GI adenocarcinoma?
Tobacco smoking
H pylori infection
alcohol intake
Japanese
What are the initial symptoms of GI cancer?
weight loss
abdominal pain
N/V
hematemessis
What is Leser-Trelat sign?
explosive onset of multiple seborrhea keratoses of the skin (within a couple weeks)

associated with GI cancer
What is Blummers shelf?
metastatic tumor felt on rectal examination

associated with GI cancer
What is used to evaluate suspect gastric caners?
EGD #1***

CT
endoscopic ultrasound
How many normal people will have an abnormal LFT test?
about 5%
What is the most common medication to raise LFT's ?
acetaminophen (tylenol)
What does an AST to ALT ratio of 2:1 or greater suggest?
alcohol abuse

will also have high GGT
What things cause erosive and hemorrhagic gastropahy?
NSAIDS
alcohol
stress
What are the endoscopic findings in erosive and hemorrhagic gastropathy?
subepithelial hemorrhages, petechia, and hemorrhages
What is the most common clinical sign of erosive and hemorrhage gastropathy?
bleeding, presenting as hematemesis, coffee ground emesis, or melena
What is the best way to diagnose erosive or hemorrhagic gastropathy?
Endoscopy is the BEST
What is stress gastritis?
mucosal erosions and hemorrhages that develop within 72 hours in critically ill pts (surgery, hospitalization)
What is the main cause of nonerosive and nonspecific gastritis?
H pylori
What tumors does h pylori predispose you for?
adenocarincoma

and low grade B cell gastric lympgoma
Does H pylori serology imply active infection?
Nope
What tests do indicate an active h pylori infection
fecal antigen
urea breath test
What are the two main causes of peptic ulcer disease?
H pylori
NSAIDS
What are the sxs of PUD?
gnawing
dull
aching
burning
or hunger like pain
What are symptoms of gastric ulcers?
Anoxeia and weight loss
N/V
What must be done with all gastric ulcers?
biopsided and follow up
what is the classic presentation of duodenal ulcers?
pain occurring 2-3 hours afte eating

also at night
What is the procedure of choice for diagnosing dudodenal and gastric ulcers?
endoscopy
What is the general approach to treating PUD?
bland diet, frequent feedings

avoid NSIADs, booze, smoking
What are the BEST drugs for PUD?
PPI's
How long do you give PPI's for uncomplicated duodenal ulcers?
4 weeks
How long do you give PPIs for uncomplicated gastric ulcers?
8 weeks
What drugs are included in the quadruple therapy for H pylori?
Quadruple therapy

PPI+ Bismuth + metronidazole + tetracycline
what drugs are included in the concomitant therapy for h pylori?
PPI, clarithromycin, amoxicillin, metronidazole
How do you get most platelet disorders?
aspirin, or ITP- so acquired
How do you get most coagulation cascade disorders?
congential defects
What test is increased in hemophilia A?
PTT (factor 8)
What tests are increased in vWF disease?
bleeding time, PTT
What test is increased in wit K deficiency?
PT (maybe PTT too)
What tests are increased in heparin/coumadin overdose?
PT and PTT
What tests are increased in DIC?
bleeding time, PT, PTT


but platelets are decreased
What defines thrombocytopenia?
less than 100,000 platelets
How does TTP present?
a microangiopathic hemolytic anemia. thrombocytopenic purpura, renal failure
What causes TTP?
unclear- but platelet aggregation
What does the periperal blood smear show in TTP?
schistocytes, and low platelets
How do you diagnose ITP?
by exclusion
Who gets ITP?
this is usually kids, with a preceding viral infection
What factor is defective in hemophilia A?
factor VIII (8)
Who gets hemophilia?
only males (x linked)
What are the genetics of von willebrands disease?
autosomal dominant
What are the vit K dependent factors?
2, 7, 9, 10
what are the three principles of managing bleeding disorders?
stop bleeding
treat cause
give blood component
What are packed red blood cells given for?
lost red cell mass
What is fresh frozen plasma given for?
factor defects, coumadin reversal, TTP tx
What are platelets given for?
platelet counts below 50,000 and clincally abnormal bleeding
What are the four phases of clotting?
vascular (disruption of wall)

platelet phase (platelet adhesion and plugging)

Coagulation- turns int a fibrin clot

fibrinolysis- dissolving clot (resolution)
where do most vascular disorders come from?
typically acquired
do all pts over age of 50 need annual fecal occult testing with guaiac cards?
NO
What are the 3 USPSTF testing regimins for colon cancer?
YEARLY Fecal occult blood testing

or

Sigmoid ever 5 years, and FOBT every 3

or

Colonoscopy every 10
What ages does USPSTF recommend screening for colon cancer for?
Age 50 thru age 75
While the american cancer society reccomends the same 3 tests for colon cancer as the USPSTF- what other 3 does it also want?
double-contracts barium enema every 5 years

or

CT colonography every 5 years

or

fecal DNA at some interval
What are four risk factors for breast cancer show in turning point?
over 50
no pregnancies
history of atypical ductal hyperplasia on biopsy
late cessation of menses
What is the biggest risk for breast cancer?
first degree relative with breast or ovarian cancer at early age
How does oral birth control affect cancer rates?
this increases them
When does the USPSTF recommend breast cancer screens?
FOR- Biennial between 50 and 74

Against self breast exam (women are too stupid to do it right)

FOR clinical breast exam over 40+
What does the american college of obstetrics and gynecology say about breast cancer screens?
mammogram every 1-2 year for 40-49

and yearly after 50

ALSO- FOR self breast exam
What age do you start doing PAP smears?
21 years old

or 3year after onset of sexual activity
What HPV types cause cervical cancer?
16,18,31,45
At what age do you start HPV testing
age 30+
What does ACOG say about negative HPV DNA test results?
HPV dna testing is very sensitive, and so if its negative, cancer risk is about 1/1000
Does USPSTF recommend testing for HPV?
no
What is Oligomenrrhea?
cycles longer than 35 days, but less than 6 months
What is hypomenorrha?
regular cycles, but with shorter duration
What is menorrhagia?
regular cycles with heavy flow, or long duration
what is metrorrhagia?
bleeding between cycles
What is Dysmenorrhea?
painful menstruation that prevents a woman from doing normal activities
What are the two types of dysmenorrhea?
primary- excess prostaglandins

secondary- identifiable cause
what chemical causes primary dysmenorrhea?
prostaglandins

common in younger women
What kinds of things cause secondary dysmenorrhea?
endometriosis
adenomyosis
PID
adhesions
leiomyomas
What is the presentation of secondary dysmenorrhea
monthly spasmodic lower abdominal pain on first 1-3 days of menses
What is primary amenorrhea?
no menses by age 13 without sexual development

or by age 15 with sexual development
what is the order of the arche is female development?
thelarche (breast)
pubarche (pubic hair)
menarche (periods)
What are the four most common causes of primary amenorrhea?
ovarian failure (tuners)
no uterus
GnRH deficiency- Kalman ansomia
constitiutional delay
what is the most common cause of secondary amenorrhea?**
pregnancy
What are the most common not pregnancy cause of secondary amenorrhea?
PCOS
hypothalamic
lactation
menopause
what is the hypothalamic cause of secondary amenorrhea?
decreased GnRH pulsatility, decreases FSH and LH
What things cause the hypothalamus to decrease GnRH pulastility?
strenuous exercise or stress

weight loss

hypothalamic lesions
What is elevated in secondary amenorrhea caused by ovarian failure?
FSH is elevated
How does Polycystc ovarian syndrome cause secondary amenorrhea?
this is hyperdrogenic, and inhibits GnRH release
what is the most common cause of androgen excess and hirsuitism?
polycystic ovarian syndrome
what hormone is in excess in PCOS?
excess LH
What are the AEIOU causes to do Dialysis?
Acidosis
Electrolyte disorder
Intoxiation (methanol, aspirin)
Overload volume
Uremia
What GFR defines chronic kidney disease
<60ml/min for 3 month of more
What drugs help in chronic kidney disease cause by HTN
ACEi

ARB's
What is renal osteodystrophy?
at Low GFR's, PTH levels rise,
bones thin
What does ADH do?
this regulates sodium concentration

increases water uptake
What does aldosteone due?
increases sodium uptake

and increases secretion of potassium
What defines hyponatremia?
sodium under 135
what is hyponatermia a disturbance of?
free water, and reflects problems in water homeostasis
What are the labs in SIADH?
low sodium in blood
high sodium in urine
high urine osmolality
low serum osmolality
how do you treat SIADH?
reduce water in take
what is the most common cause of diabetes insipidus?
idiopathic low ADH secretion
What is functional constipation?
this is constipation with no identifiable cause
what is encopresis?
regular, voluntary or involuntary pooping your pants after age 4
what is Soiling?
involuntary passage of stool associated with fecal impaction
what is are the key signs of hirschsprung disease?
delayed passage of meconium
chronic constipation
soiling
empty rectum and tight sphincter
What is functional constipation?
this is constipation with no identifiable cause
what is encopresis?
regular, voluntary or involuntary pooping your pants after age 4
what causes anal fissure?
big hard dump
what is Soiling?
involuntary passage of stool associated with fecal impaction
What is primary enuresis?
incontinence in a child who has NEVER achieved dryness
what is are the key signs of hirschsprung disease?
delayed passage of meconium
chronic constipation
soiling
empty rectum and tight sphincter
what is secondary enuresis?
incontinence in a child who has been dry for at least 6 months
what causes anal fissure?
big hard dump
What is primary enuresis?
incontinence in a child who has NEVER achieved dryness
what is secondary enuresis?
incontinence in a child who has been dry for at least 6 months
What is the spontaneous remission rate of enuresis?
15%
does enuresis usually run in families?
yes it does, the parents often had it as kids
What should a exam for enuresis include?
observation of kid for abuse
and noting child parent interaction
what are the treatments for enuresis?
conditioning therapy- enuresis alarm LOL
pharmacotherapy
hypnotherapy
What is reflux nephropathy?
renal scarring from the vesicoureteral reflux
What structural conditions lead to vesicoureteral reflux?
duplication of ureters

neurogenic bladder
What are the diganostic studies you should do with in kids up to age 6 with a first documented UTI?
voiding cystourethrogram VCUG

radionuclide cystogram NCG
what type of scan best identifies renal scars (in vesixoureteral reflux)
nuclear renal scanning
what are the complications of VUR?
HTN, chronic kidney disease
What is the triad of HUS?
microangiopathic hemolytic anemia
thrombocytopenia
renal injury/ acute renal
How do you tell TTP from HUS?
TTP does NOT have a diarrheal prodrome!
What is pubarche?
appearance of hair, oily skin, acne, body odor
What does adrenarche NOT include?
development of breasts or testicular enlargment
What does Gonadarche cause in males?
pubic hair, axially hair, manly stuff
increases penile size, increased testicular volume
What is Kallmann synrome?
gonadotropin deficiency with disorders of olfaction
How does increased phyiscal activity change the onset of menarchy?
this can delay onset
When should you consider Turner syndrome?
any girl who is short without a contributary history
What is precocious puberty?
early development of secondary sex characteristics (before 8)
what is gonadarche?
maturation of gonad and secretion of sex steroids
What is the normal developmental sequence in girls puberty?
thelarche (breast)- due to gondarache

pubarche (due to adrenarche)

menarche 2-3 years later
What is central precocous puberty?
all development comes early- usualyl constitiutional or familial basis
What is McCune-Albright syndrome?
this is the most common cause of GnRH independent precocious puberty
What are the signs of McCune-Albright syndrome?
cafe au lait spots
early gonadarche
bone disorder

hyperthyroidism, hyperadrenalism, acromegaly may occur too
When do you get the disease in a case control vs cohort study?
cohort studies- compare disease incidence between exposed vs. unexposed


case control- compares diseased vs. well
What is absolute risk?
this is number of new cases per year
What study type CANNOT use absolute risk?
case control, because you can assess incidence (due to the population being non random)
What is absolute risk reduction?
AR of exposed- AR of unexposed (AR being # of new cases/ total)
What is relative risk? (RR)
AR exposed/ AR unexposed
What does a RR=1 mean?
no evidence you've identified a risk factor
What does RR >1 mean?
evidence for risk factor (risk in exposed is greater than risk in unexposed)
What does RR<1 mean?
evidence for protective factor
What is the Odds ratio?
ad/bc

(when using a square chart)
What is the number need to harm ?
NNH = 1/ Absolute Risk reduction

(ARR = AR exposed - AR unexposed)